The use of health information technology (IT) has increased dramatically over the past decade, and has helped to improve patient safety through practices such as electronic prescribing. Yet as many of us have seen, health IT can bring with it unintended consequences, some of which pose new risks to patient safety.

NPSF is a member of the Partnership for Health IT Patient Safety, a multistakeholder group convened by ECRI Institute’s Patient Safety Organization (PSO) in 2013. Other members include health care providers, health IT vendors, academic researchers, patient safety organizations, and professional societies. Through the collection, analysis, and sharing of health IT data and information, the partnership seeks to inform the national strategy for health IT patient safety, provide useful recommendations for all stakeholders, and in identify ways that health IT can be used to improve patient safety.

I serve on the partnership’s expert advisory panel and had the honor of chairing one of the first workgroups, addressing “copy and paste” functionality in health IT systems. Earlier this year, the partnership released the workgroup’s recommendations as part of a publicly available resource, Heath IT Safe Practices: Toolkit for the Safe Use of Copy and Paste.

Copying and pasting with the medical record is a widespread practice. Studies of varying disciplines in diverse settings indicate anywhere from 5% to 90% of notes contain copy and pasted text. This practice can improve documentation efficiency and completeness, but also represents a significant risk, as clinicians may unknowingly populate the record with old, inaccurate, or excessive information.

Our workgroup focused specifically on functionality and how to use it to increase, not detract from, patient safety. Our task was to define copy and paste, review the literature, and review events reported to ECRI Institute’s PSO. We also talked about vendor functionalities and looked at best practices of some exemplary organizations before finalizing the recommendations. The ECRI team and the workgroup did a terrific job of synthesizing the results of these deliberations.

Broadly, our recommendations cover four areas, most of which entail action by both health IT vendors and provider organizations:

Recommendation A: Provide a mechanism to make copy and paste material easily identifiable.

It’s crucial for clinicians to be able to easily identify text that has been copied and pasted so they can more easily verify its accuracy and review it for needed edits. This potentially can be achieved by use of a split screen or different formats (for example, use of italics) for copied material.

Recommendation B: Ensure that the provenance of copy and paste material is readily available.

Clinicians need to be able to figure out fairly easily where the copied material originated, which helps verify its accuracy and appropriateness. One example of a potential solution is for information about the copied material to “hover” over it when it is being accessed.

Recommendation C: Ensure adequate staff training and education regarding the appropriate and safe use of copy and paste.
One of the benefits of copy and paste functionality is that it is a quick and efficient way to document complex information – especially if the information does not change much over time. Clinicians are of course responsible for the content and accuracy of their notes, but in the midst of a busy schedule, the safety risks may elude them. Ongoing education and training are needed about the best ways to optimize its use, and the toolkit provides examples of this kind of education.

Recommendation D: Ensure that copy and paste practices are regularly monitored, measured, and assessed.
Health care provider organizations and vendors need to work together to create audit tools and audit policies to monitor the use of copy and paste by providers. By auditing use, they can help ensure the integrity of the clinical record, as well as the quality and safety of care, and gather information on what type of data are commonly copied and pasted, in order to potentially create new solutions or tools. Examples of audit measures and policies are also in the toolkit.

I encourage all those involved in health care and in health IT to download the toolkit and consider implementation of the recommendations.

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